Tag Archives: Massage

The mysterious case of the breast enlargement scar and knee pain

This was brought to my attention, and indeed, received comments galore after it was posted on a social media platform;

‘HAHAHAH! This got me buzzing yesterday in clinic. Female, mid 50s, avid runner comes to see me for bilateral knee pain when running. Quads were mega jacked up! Super tight. Found the quads were weak! Nothing stood out in her history and she’d been following a progressive program with running, so programming and equipment wasn’t the issue. It was her boob job scars! They were causing all the issues!!! Temporary correction relieves her knee pain. Further testing revealed it was the left sided scar screwing things up. So left boob scar gets the treatment!’

Okay, I imagine the majority of people reading this, as I did initially thought ‘well that’s odd’. However, it was not the scar versus bilateral knee pain it was ‘temporary correction and boob scar get’s the treatment’. As you may imagine this attracted numerous comments, the majority incredulous at what has happened in this session. Further explanations were forthcoming;

History and movement testing. Temporary scar work relieves bilateral knee pain. Check the work. Still no problems, fully correct the scar. I was hands off and no flesh was exposed. She did the palpating’.

Now I am thinking, other than the obvious, let’s get back to the knee pain, where is the explanation of what was happening from a biomechanical perspective, (following a progressive program but no information about strength and conditioning program), we have weak quads’ that are very tight, would a graded exercise plan not be more appropriate in this instance as the last time I saw a programme concerning cosmetic surgery the scars are quite minimal and as at the time of writing this can find no evidence to the same.

So how does the individual concerned know thisI invest a lot into geeking up-courses, books, articles, a LOT with hiring top therapists/ practitioners arou d the world via Skype to learn from them. Chiros, physios, massage therapists, TCM, personal trainers, etc. I Skype with then to learn. Some stuff is newly developed and the practitioners are either waiting for supporting research/ its their own developments, ao proprietary stuff that I’ve agreed not to teach.’

So, we have a cure for weak quads that is resolved in one session but no answer telling the world how this works. I can assure you if I had a magical touch I’d be shouting from the roof tops, hitting the lecture circuit all the while becoming a guru to millions.

Now, before I finish, I am aware of Anatomy Trains, research into scar tissue, stretching of fascia etc, the list goes on and on but as a profession can we be taken seriously when we have a secret weapon to cure tight weak quads by rubbing breast enlargement scars?

What am I missing here?! How can a knee be connected to a breast scar? Please help me to understand or is it as I suspect a specific form of woo practice.


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Pre and Post Event Soft Tissue Therapy

I have often wondered why an individual would want to plonk their sweaty bodies on a plinth after completing an event, even more so in the winter when they are generally covered in the dirt of the roads or fields that mixes well with the sweat. Is it because it is ‘part of the experience’, this is what a professional does or is it altruistic in that they can give to charity. Does the therapist look to gain profile whilst giving up their time or do they earn during the day. If it’s the latter then fair enough but if it’s the former how many competitors come back when they have to pay, I’m sure someone can guide me.

I’ve been trying to think this through as it makes little sense to me to stand around in the heat or cold waiting to get a 15 minute, maximum, gentle rub down when you could have had some protein, a stretch, food then be on your way home.

A recent article by Paul Ingram (www.painscience.com), 14 August 2015, titled ‘Massage impairs post exercise muscle blood flow and lactic acid removal’ In this piece he summarises as follows;

‘One of the classic claims of massage therapy is that it “aids muscle recovery from exercise … by increasing muscle blood flow to improve ‘lactic acid’ removal.” But this 2009 evidence shows that just the opposite may be the case, in at least some circumstances. It was a straightforward experiment: the researchers subjected twelve people to intense hand-gripping exercises and then measured their blood acidity with and without basic sports massage. Their measurements showed that massage significantly “impairs lactic acid and hydrogen ion removal from muscle following strenuous exercise by mechanically impeding blood flow.” Yes, you read that right: massage impairs.

That’s quite a surprising result that applies a firm push to the side of a classic sacred cow of massage lore.

Here is the original abstract in full;

Wiltshire EV, Poitras V, Pak M, Hong T, Rayner J, Tschakovsky ME. Massage impairs post exercise muscle blood flow and lactic acid removal. Med Sci Sports Exerc. 2010 Jun;42(6):1062–71. PubMed #19997015.

PURPOSE: This study tested the hypothesis that one of the ways sports massage aids muscle recovery from exercise is by increasing muscle blood flow to improve “lactic acid” removal.

METHODS: Twelve subjects performed 2 min of strenuous isometric handgrip exercise (IHG) at 40% maximal voluntary contraction (MVC) to elevate forearm muscle lactic acid. Forearm blood flow (FBF; Doppler and Echo ultrasound of the brachial artery), and deep venous forearm blood lactate and H concentration ([La-], [H]) were measured every minute for 10 min post-IHG under three conditions: Passive (passive rest), Active (rhythmic exercise at 10% MVC), and Massage (effleurage and petrissage). Arterialized [La] and [H] from a superficial heated hand vein was measured at baseline.

RESULTS: Data are mean +/-SE. Veno-arterial [La] difference ([La]v-a) at 30 s post-IHG was the same across conditions (mmol/L; Passive 6.1 +/-0.6, Active 5.7 +/-0.6 mmol/L, Massage 5.5 +/-0.6, NS), while FBF (ml/min) was greater in Passive (766 +/-101) vs. Active 614 +/-62 (P=0.003) and vs. Massage 540 +/-60 (P<0.0001). Total FBF area under the curve (AUC; ml) for 10 min post handgrip was significantly higher in Passive vs. Massage (4203 +/-531 vs. 3178 +/-304, P=0.024) but not vs. Active (3584 +/-284, P=0.217). La- efflux (mmol; FBF x [La]v-a) AUC mirrored FBF AUC (Passive 20.5 +/-2.8 vs. Massage 14.7 +/-1.6, P=0.03 vs. Active 15.4 +/-1.9, P=0.064). H+ efflux (mmol; FBF x [H]v-a) was greater in Passive vs. Massage at 30 s (2.2 +/-0.4 e-5 vs. 1.3 +/-0.2 e-5, P<‘0.001) and 1.5 min ( 1.0 +/-0.2 e-5 vs. 0.6 +/-0.09 e-5, P=0.003) post-IHG.

CONCLUSION: Massage impairs La- and H+ removal from muscle following strenuous exercise by mechanically impeding blood flow.

Whatever you think of the research the effect is brought to home by a recent article by Phil Burt, Lead Physiotherapist at Great Britain Cycling Team and Team Sky. This is what he has to say ‘There is a reasonable amount of evidence that massage immediately before an activity can reduce the amount of power that an athlete can produce. In the “golden hour” between team pursuit heats, unlike many teams, we don’t give the riders a “flushing out” rub down. Compared to their nutrition, cool-down and subsequent warm-up routine, it is way down the order in terms of recovery techniques, of questionable physiological benefits and may even have a negative impact on their performance in the next round.

Also some of the more aggressive soft tissue therapy techniques are quite painful, as they can result in bruising and are fairly draining, are definitely not recommended in the lead up to an event.

The above withstanding he does continue ‘Again, it comes down to personal preference and what works for you. A regular, say monthly, appointment with an experienced soft tissue therapist can be useful as a body MOT and can help identify areas of tightness or concern. Also, do not underestimate the psychological aspect either. If a massage helps you to feel good, increases your motivation to train or you feel that it improves your performance, do it’

So, instead of thinking, this rub is doing me some good the individual should be looking to;

Refuel – Sweet rice and fruit/chicken or turkey tacos/chicken fried rice – The Feed Zone – Dr Allen Lim

Rehydrate – Drink

Repair -Good quality whey Protein

Recover – Power nap

That does not include beer, a study by Yann Le Meur (@YLMsportscience) indicates that within 4 hours, post exercise, you will be as dehydrated as when you finished your event.

This is not a rant about the soft tissue industry, I am part of it, but is an open thought on how an individual may be better off looking at alternative ways of recovery rather than waiting around for upwards of an hour, I’ve seen it, to get a rub when the benefit is negligible. Instead come and see me and my fellow therapists 2 – 3 days after the event so we can give you our undivided attention and specific treatment.

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